Over half the people of Nairobi live in densely populated urban slums. Residents are exposed to severe environmental risks, including poor sanitation, lack of potable water, poor drainage and uncollected refuse, resulting in high rates of morbidity and mortality.
A UNFPA-supported project, launched with the Nairobi City Commission in 1993, has sought to improve health conditions by establishing an integrated health and family planning delivery system involving both clinics and community-based outreach. By October 1995, the project had trained 465 residents to distribute contraceptives in their communities and deliver messages on reproductive health, including family planning, pre- and post-natal care, nutrition, immunization, a clean environment and safe sex. The distributors also help with home-based care of people with AIDS.
Trained nurses working as supervisors provide a link between the community and the health centres. They assist the distributors by taking blood pressure and providing counselling in clients' homes. Both supervisors and distributors work to mobilize community education campaigns on family planning and on AIDS. They also carry contraceptive commodities to the market on market day to reach clients who do not have time to go to the clinics.
The project also organizes workshops for health workers on primary health care concepts and family planning technology, and for local officials on community participation in health and development activities.
Two of the slum communities have formed volunteer village health committees to work for a clean environment; the committees manage water kiosks as an income-generating activity. The project has provided cleaning tools and materials for building garbage centres, one public toilet and storm water drainage.